Utility of the peripheral smear and laboratory studies in the ...

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Neonatal Erythropoiesis Intrauterine environment relatively hypoxic Mom’s blood not quite fresh from the lungs Higher oxygen affinity of Hgb F Oxygen rich environment after birth shuts down EPO production RBC production decreased by factor of 2 to 3 in first few days, by 10 in first week Nadir of production is 2nd week
Neonatal Erythropoiesis Hgb relatively stable 1st week of life, then gradually falls – nadir is 6-12 weeks of age “physiologic anemia of the newborn” Generally should not fall below 9.5 g/dL MCV also falls Our lower limit is 72 fL Reticulocyte count in increased at birth & first few days of life, 0-2 days 3-7% 3-4 days 1-3% >4 days down to 0.5-1.5%
Page 1 and 2: Utility of the Peripheral Smear and
Page 3: Fetal Hematopoiesis Hematopoiesis s
Page 7 and 8: Laboratory Evaluation of the Neonat
Page 9 and 10: Notes on Pediatric Normal Hematolog
Page 11 and 12: Notes on Neonatal Platelets Co
Page 13 and 14: TCH MCV Normal Range Age FL 0-30 da
Page 15 and 16: TCH WBC Normal Range Age x103 /μL
Page 17 and 18: TCH Platelet Normal Range Platelet
Page 19 and 20: Anemia Basics Mechanisms: Increa
Page 21 and 22: The CBC in Classification of Anemia
Page 23 and 24: Approach to the PBS Start with th
Page 25 and 26: Utility of the PBS Review Anemic p
Page 27 and 28: Utility of the PBS Review WBC Co
Page 29 and 30: Immature Lymphoid Cells
Page 31 and 32: Mature Lymphocytes
Page 33 and 34: Look at the Forest for the Trees Ar
Page 35 and 36: “Private School” Lymphoblasts
Page 37 and 38: Special Considerations for the Peri
Page 39 and 40: Morphologic Findings on Peripheral
Page 41 and 42: Morphologic Findings on Peripheral
Page 43 and 44: Occasional nucleated red cells, tar
Page 45 and 46: Acanthocytes, target cells, immatur
Page 47 and 48: Howell Jolly body - normal in first
Page 49 and 50: Polychromasia - retic is higher in
Page 51 and 52: Case #1 15 month old girl
Page 55 and 56:
Hypochromic Microcytic Anemia: Diff
Page 57 and 58:
Iron Studies Serum iron = 5 ug/dl S
Page 59 and 60:
A word about Fe deficiency Most
Page 61 and 62:
Case #2 3 year old boy
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What do we see? Microcytic hypochro
Page 68 and 69:
Iron Studies Serum iron = 30 ug/dl
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Final Diagnosis Beta thalassemia tr
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Diagnosis of Thalassemia Beta El
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CBC Differences from Iron Deficienc
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What do we see? Extreme hypochro
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Hemoglobin Fractionation Hgb
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Alpha Thalassemia 4 alpha gen
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Case #4 6 year old girl with fatigu
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What do we see? Spherocytes
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Additional Labs LDH = 926 U/L In
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Results Direct antiglobulin test
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Hereditary Spherocytosis Incidence
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Hereditary Spherocytosis Presents i
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Case #5 16 year old boy
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Hereditary Elliptocytosis Seen in a
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Diagnosis? Hereditary Pyropoikilocy
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Hereditary Pyropoikilocytosis
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What do we see? Spherocytes again L
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Spherocytes on the Smear Sphe
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CBC Hgb = 6.8 g/dL Hct = 18.5
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Differential Diagnosis TTP HU
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Labs Elevated BUN/Cr Elevated
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Final Diagnosis Hemolytic Uremic Sy
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Hemolytic Anemias - In General
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CBC Findings in Hemolytic Anemia An
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Hemolytic Anemia on PBS Usually nor
Page 134 and 135:
Hemolytic Anemia on PBS WBC usually
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Peripheral Smear Clues Extravascula
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What do you see? Acanthocytes (Spur
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Differential Diagnosis for lots of
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Acanthocytes Echinocytes Color Atla
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Case #10 14 year old boy with anemi
Page 151 and 152:
Sickle Cells & Targets - Problem No
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Case #10 Diagnosis Heterozygous sic
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Sickle Cell Disease Hypochromia &
Page 157:
Any questions, y’all? Adapted fro
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